Impact of Timing of Admission in Labour on Maternal and Perinatal Outcomes: An Observational Study From a Tertiary Care Centre in India

TL;DR

This study finds that admitting women in active labor (≥5 cm) leads to fewer interventions and better outcomes compared to later admission.

Contribution

The study provides evidence for optimizing admission timing in labor to reduce unnecessary interventions in low-risk pregnancies.

Findings

Admission in active labor was associated with lower augmentation rates and fewer interventions.

Cesarean sections in active labor were mainly due to cephalopelvic disproportion, while in the second stage due to deep transverse arrest.

NICU admission was required in 6.3% of neonates, with no significant differences between admission groups.

Abstract

Background: The timing of hospital admission in labour influences the course and outcomes of delivery. Early admission during the latent phase is often associated with increased interventions and caesarean section rates, while admission in the active phase is linked to shorter labours and improved outcomes. 
Objective: This study aims to compare maternal and perinatal outcomes between women admitted in the active phase (≥5 cm) and those admitted later in the second stage of labour.
Methods: This observational study included 172 women ≥37 weeks admitted in spontaneous labour at a tertiary care hospital in southern India. Data from case records were extracted on maternal demographics, stage of labour at admission, intrapartum interventions (artificial rupture of membranes, oxytocin augmentation), mode of delivery, maternal complications, and neonatal outcomes. Descriptive statistics and Chi-square/t-test were used, with p < 0.05 considered significant.
Results: Of 172 women, 93 (54.1%) were admitted in active labour and 79 (45.9%) in the second stage. Vaginal delivery occurred in 80.8%, and cesarean section in 13.3%. Caesarean section in active labour was most often for cephalopelvic disproportion (47.3%), whereas in the second stage it was predominantly for deep transverse arrest (75%). Neonatal intensive care unit (NICU) admission was required in 6.3% of neonates. Women admitted in active labour had lower augmentation rates, fewer interventions, and shorter labours when compared to women in second labour, but it was not significant (p > 0.05).
Conclusions: Admission after confirmed onset of active labour (≥5 cm) is associated with reduced intrapartum interventions and lower operative delivery rates. Adopting this threshold in low-risk term pregnancies may optimise maternal and perinatal outcomes and reduce unnecessary interventions.